Added codes
Effective May 1, 2018
Implantable Bone Conduction and Bone-Anchored Hearing Aids, 7.01.547
Now requires review for medical necessity, now requires prior authorization
L8694 - Auditory osseointegrated device, transducer/actuator, replacement only, each
Orthoptic Training for the Treatment of Vision or Learning Disabilities, 9.03.03
Now requires review for medical necessity
92065 - Orthoptic and/or pleoptic training, with continuing medical direction and evaluation
Removed codes
Effective May 1, 2018
Chelation Therapy, 8.01.535
No longer requires medical necessity review
J3520 - Edetate disodium, per 150 mg
Intracellular Micronutrient Analysis, 2.04.73
No longer requires investigational review
86353 - Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis
88348 - Electron microscopy, diagnostic
Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure, 6.01.56
No longer requires investigational review
A9582 - Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
Retinal Prosthesis, 9.03.15
No longer requires investigational review
0100T - Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy
Transtympanic Micropressure Applications as a Treatment of Meniere Disease, 1.01.23
No longer requires investigational review
A4638 - Replacement battery for patient-owned ear pulse generator, each
E2120 - Pulse generator system for tympanic treatment of inner ear endolymphatic fluid